OPINION: Depression, disability and 'safe' euthanasia

By
HANNAH GRAHAM

Despite the complexity and sensitivity of the issues involved, issues of mental illness and disability need to be given careful thought in considering whether to legalise euthanasia and assisted suicide in Tasmania.

Hannah Graham is an Associate Lecturer in Criminology & Sociology in the Faculty of Arts and a research assistant in the Faculty of Law at the University of Tasmania.

Despite the complexity and sensitivity of the issues involved, issues of mental illness and disability need to be given careful thought in considering whether to legalise euthanasia and assisted suicide in Tasmania.

In the few jurisdictions where it is legal, there is evidence that people with mental illnesses and disabilities have been euthanased or assisted to end their lives, despite the presence of 'safeguards.'

In pushing for euthanasia law reform, Lara Giddings and Nick McKim claim their proposed safeguards will protect vulnerable Tasmanians.

Ms Giddings recently stated ``there is no evidence from any international jurisdiction of these laws being abused or of vulnerable people being disproportionately represented in the statistics from overseas'' (The Mercury, 26/09/2013).

Yet from an academic perspective, the international evidence is much more mixed and contested than proponents acknowledge.

This evidence is analysed in a research paper I have co-written with Dr Jeremy Prichard of the Faculty of Law, University of Tasmania.

Various studies and reports show that people with mental illnesses and disabilities have been disproportionately euthanased or assisted to kill themselves in Belgium, the Netherlands and Oregon in the United States - despite the presence of safeguards.

In the Netherlands and the Flanders region of Belgium, there are troubling rates of voluntary and non-voluntary euthanasia of people with mental illnesses and dementia.

In Oregon, doctors are asked to refer patients seeking assisted suicide to a psychiatrist if there is suspected or diagnosed mental illness, to assess competency and ensure informed consent.

This safeguard is not mandatory. Oregonian official statistics show that these rates of referral to a psychiatrist dropped from 31% of patients in 1998 to 2% in 2012.

Several studies indicate that people with depression have accessed assisted suicide in Oregon.

A 2008 survey found that, out of those terminally ill Oregonian patients in the study who requested assisted suicide, one in four had clinical depression. Of those who received a doctors prescription for a lethal drug, one in six had clinical depression.

Euthanasia and assisted dying laws may create a confusing double standard for who is the focus of suicide prevention and who is the focus of suicide assistance.

Yet, excluding people on the grounds of depression or disability may be contested as discriminatory, leaving eligibility restrictions open to subsequent challenge in parliament or the courts.

In their paper and model released in February 2013, Lara Giddings and Nick McKim draw links between quality of life and notions of dignity and autonomy.

In essence, they suggest that, in the event of 'poor quality of life' and 'intolerable suffering', people who are eligible should be able to seek assistance to end their lives.

Persuasive criticisms of this type of argument have been raised by disability rights advocates around the world.

Many disability advocates oppose euthanasia and assisted suicide on the grounds that it has adverse implications for people with disabilities, whether or not they are eligible for it.

People who choose to live with symptoms and conditions that others call `intolerable suffering' and `poor quality of life' may find pro-euthanasia messages that some people are `better off dead' and `some lives are not worth living' offensive and stigmatising.

She argues that legalising it "reinforces prejudices for people with disabilities'' and makes them "afraid of a law that would offer a lesser standard of protection to seriously ill people than to others.''

James McGaughey, Executive Director of the Office of Protection and Advocacy for Persons with Disabilities in Connecticut agrees that disability advocates are ``deeply concerned'', saying "the disability rights movement [is] punctuated with stories of individuals who "just wanted to die'' before coming to realise they could still lead good, contributing lives.

Advocates worry that some people would never get to that realisation if assisted suicide becomes legal.''

Saying the proposed Tasmanian Voluntary Assisted Dying model is based on Oregon, Belgium and the Netherlands, while denying that the euthanasia of vulnerable people could happen here means proponents may be willing to downplay or ignore what is already happening elsewhere.

Thoughtful discussions of euthanasia and vulnerability need to extend deeper and further than the narrow and uncomplicated view that this debate is simply about a purported individual `right to die.'

A compelling evidence-based case for changing the law has not been produced in Tasmania.